title: Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q).
abstract: BACKGROUND
  Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations.
  
  
  METHODS
  Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish.
  
  
  RESULTS
  The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors.
  
  
  CONCLUSIONS
  By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations.
authors.affiliation: Department of International Health, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, P,O, Box 616, 6200, Maastricht, MD, the Netherlands. k.sorensen@maastrichtuniversity.nl.
authors.forename: Kristine
authors.initials: K
authors.lastname: Sørensen
authors.forename: Stephan
authors.initials: S
authors.lastname: Van den Broucke
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Pelikan
authors.forename: James
authors.initials: J
authors.lastname: Fullam
authors.forename: Gerardine
authors.initials: G
authors.lastname: Doyle
authors.forename: Zofia
authors.initials: Z
authors.lastname: Slonska
authors.forename: Barbara
authors.initials: B
authors.lastname: Kondilis
authors.forename: Vivian
authors.initials: V
authors.lastname: Stoffels
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.forename: Helmut
authors.initials: H
authors.lastname: Brand
mesh_terms: D000328:Adult; D005006:Ethnicity; D005060:Europe; D005260:Female; D057220:Health Literacy; D006305:Health Status Indicators; D006306:Health Surveys / Q000592:standards; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*